Medicare

Medicare Open Enrollment: Five Things You Need to Do

November 30, 2015 • By

Last Updated: November 30, 2015

medicare 50th anniversary Routines help keep us focused, organized, and even healthy. However, if your health routine doesn’t include preparing for Medicare’s Open Enrollment, now’s the time to kick-start a new healthy habit.

If you have a Medicare health or prescription drug plan, you should review and compare coverage options. The Open Enrollment runs through December 7 and is the time you can make changes to your plan. Even if you’re happy with your current coverage, you might find a better fit for your budget or your health needs. If you miss an Open Enrollment deadline, you’ll most likely have to wait a full year before you can change your plan.

Here are five things every Medicare beneficiary can do to get in the Medicare Open Enrollment routine.

  1. Review your plan notice. Be sure to read any notices from your Medicare plan about changes for next year, especially your “Annual Notice of Change” letter. Look at your plan’s information to make sure your drugs are still covered and your doctors are still in network.
  1. Think about what matters most to you. Medicare health and drug plans change each year and so can your health needs. Do you need a new primary care doctor? Does your network include the specialist you want for an upcoming surgery? Does your current plan cover your new medications? Does another plan offer the same value at a lower cost? Take stock of your health status and determine if you need to make a change.
  1. Find out if you qualify for help paying for your Medicare. Learn about programs in your state to help with the costs of Medicare premiums, your Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) deductibles, coinsurance and co-payments, and Medicare prescription drug coverage costs. Visit Medicare.gov or make an appointment with a local State Health Insurance Assistance Program (SHIP) counselor if you need help.
  1. Shop for plans that meet your needs and fit your budget. You can use the Medicare Plan Finder tool to see what other plans are offered in your area. A new plan may:
  • Cost less;
  • Cover your drugs costs; or
  • Let you use the providers you want, like your doctor or pharmacy.

If you find that your current coverage still meets your needs, then you don’t need to make any changes. Remember, during Medicare Open Enrollment, you can decide to stay in Original Medicare or join a Medicare Advantage Plan. If you’re already in a Medicare Advantage Plan, you can switch back to Original Medicare.

  1. Check your plan’s star rating before you enroll. The Medicare Plan Finder includes Star Ratings for the 2016 Medicare health and prescription drug plans. Plans are rated for quality on a one- to five-star scale: one star represents poor performance and five stars represent excellent performance. Be sure to use the ratings to compare the quality of any health and drug plans you are considering.

These are a few easy ways to get a jump-start on your Medicare Open Enrollment. For more information, call 1-800-MEDICARE (1-800-633-4227) and say “Agent.” TTY users should call 1-877-486-2048. Help is available 24 hours a day, including weekends. If you need help in a language other than English or Spanish, let the customer service representative know the language. You can also visit a local SHIP counselor. SHIP counselors provide free, one-on-one, non-biased Medicare assistance. Get free personalized health insurance counseling by calling your SHIP at the number listed on the Medicare contacts page or call 1-800-MEDICARE.

 


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About the Author

Dr. Patrick Conway, CMS Principal Deputy Administrator and Chief Medical Officer

Comments

  1. Piet V.

    How to I help my mom cancel medicare? She lives outside the US, and has full insurance there through the local government. She hasn’t live in the US for 50 years. Oh, and I need to make the change for her, because she has dementia, and you don’t recognize power of attorneys even if issued by the court in her country of residence.

  2. Geshew

    Hi,

    I am completing 65 yrs of age at the end on April 2021. I have health insurance from my wife’s company, for life. I was told that I need to apply for Medicare 2 months before the end of April. I am confused. What should I do and when should I apply for Medicare? Please advise. Thanks

    Geshew R

    • Vonda

      Hi Geshew, thanks for using our blog. In most cases, if you don’t sign up for Medicare when you’re first eligible, you may have to pay a higher monthly premium which is why we advise people to apply for Medicare benefits as soon as they are eligible. However, if you were covered under a group health plan based on your or your spouse’s current employment, you may qualify for a Special Enrollment Period (SEP) that will let you sign up for Medicare Part B. You have an 8-month SEP to sign up for Part A and/or Part B that starts at one of these times (whichever happens first):
      • The month after the employment ends
      • The month after group health plan insurance based on current employment ends.

      Usually, you don’t pay a late enrollment penalty if you sign up during a SEP.

      If you don’t qualify for an SEP, you can apply for Medicare online if you are within three months of age 65 or older. If you’re not ready to start your monthly Social Security benefits yet you can use our online retirement application to sign up just for Medicare and wait to apply for your retirement or spouses benefits later.

      You can call us at 1-800-772-1213 for assistance or you can contact your local Social Security office. Please look for the general inquiry telephone number at the Social Security Office Locator. The number may appear under Show Additional Office Information. Please be aware that our call wait times are longer than normal. We hope this information helps.

      • Geshew

        Hi Vonda,
        Thanks. But..I am still employed for another 8 years and my wife will be still employed for another 8 years. None of us are not ending our employment. We both have health insurance for life from her previous employer. I was told to sign up for Medicare, 2-3 months from my birthdate at the end of April. So now this “you have an 8-month SEP to sign up for Part A and/or Part B that starts at one of these times (whichever happens first):
        • The month after the employment ends
        • The month after group health plan insurance based on current employment ends. What happens now, since we don’t fall in this criteria? When should I apply for Medicare Part A / and or Part B? I am still confused. Where should I go to signup? Thanks

        • Vonda

          Hi Geshew, thanks for your questions. You can call your local Social Security office with additional questions. Please look for the general inquiry telephone number at the Social Security Office Locator. The number may appear under Show Additional Office Information. Please be aware that our call wait times are longer than normal.

  3. Claudia

    I have uhc from my husbands work for another 4 years. How do I drop plan b.

    • Vonda

      Hi Claudia, thanks for using our blog. Check out our Frequently Asked Questions web page for details on how to terminate Medicare Part B. We hope this helps!

  4. Janet A.

    I am looking to retire at 64 yr old, can I get any part of medicare

    • Vonda

      Hi Janet, thanks for using our blog. Medicare is our country’s health insurance program for people age 65 or older. Certain people younger than age 65 can qualify for Medicare, too, including those with disabilities and those who have permanent kidney failure. Check out our Medicare Benefits web page for more details.

  5. Bruce N.

    I will turn 65 in January of 2022, and ma currently receiving social security benefits. Will I automatically be enrolled in Medicare or do I have to apply for benefits?Thanks

    • Vonda

      Hi Bruce, thank you for using our blog. Generally, individuals receiving Social Security benefits are automatically enrolled in Medicare Parts A and B. Check out our Medicare Benefits web page for more details.

  6. Robert G.

    I have moved to Canada and I wish to cancel my Medicare coverage. I contacted Medicare, but they said I needed to speak with Social Security. I have called the SSA number several times, but no one answers the call. Can you help me please? Thanks.

    • Vonda

      Hi Robert, thanks for using our blog. Check out our Frequently Asked Questions web page for details on how to terminate Medicare Part B. We hope this helps!

  7. Mark H.

    I need a “Notice of Medical Insurance Enrollment and Premium Deduction” form. Can you please send me mine? Thanks,
    Mark

    • Vonda

      Hi Mark, thanks for using our blog. Check out our Frequently Asked Questions web page for details on how to get a benefit verification letter. This letter is sometimes called a budget letter, a benefits letter, a proof of income letter or a proof of award letter. You also may be able to request a benefit verification letter by using our automated telephone service at 1-800-772-1213. You can conduct the automated services 24 hours a day. At the prompt, indicate that you’re requesting a proof of income letter. We hope this helps.

  8. larraine w.

    I will be turning 65 yo in March. I am still actively working and have health insurance through my employer. I plan to continue working for a few more years. Do I still need to “register” when I turn 65, even though I do NOT want to draw SS income and do NOT need to have Medicare–do I still need to apply?

    • Vonda

      Thanks for your question, Larraine. If you are covered under a group health plan based on current employment, you may qualify for a Special Enrollment Period (SEP) that will let you sign up for Medicare Part B after age 65. You have an 8-month SEP to sign up for Part A and/or Part B that starts at one of these times (whichever happens first):
      • The month after the employment ends
      • The month after group health plan insurance based on current employment ends.

      Usually, you don’t pay a late enrollment penalty if you sign up during a SEP.

      You should always check with your health benefits advisor, or health plan representative to see what’s best for you. To learn more about the Medicare enrollment periods visit http://www.Medicare.gov. For further assistance, call your local Social Security office. Look for the general inquiry telephone number at the Social Security Office Locator. The number may appear under Show Additional Office Information. Please be aware that our call wait times are longer than normal. We hope this information helps.

      • M E.

        What do you mean by “usually ….. don’t pay a penalty”? Under what circumstances is a penalty owed?

        • Vonda

          Hi. Check out our Frequently Asked Questions web page for details on how to sign up for Part B when you already have Part A. It’s important to follow the steps and ensure you employer completes the CMS-L564 properly, showing us that you have been actively employed and covered by an employer group health plan through that active employment. We hope this is helpful!

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